Botox Utilization Review Specialist - Phoenix, AZ
HealthOp Solutions·Phoenix, Arizona
HealthOp Solutions·Phoenix, Arizona
The specialist is responsible for obtaining insurance authorizations for therapeutic Botox treatments by reviewing medical records for clinical necessity. They manage the end-to-end authorization process, including submitting requests, verifying benefits, and handling appeals for denied claims.
$20–25 per hour Why work with us: This position plays a vital role in ensuring patients receive timely access to medically necessary therapeutic Botox treatments. The role offers a consistent weekday schedule and the opportunity to work closely with clinical teams and insurance payers in a fast-paced, supportive healthcare environment. What our ideal new team member looks like: The ideal team member is detail-oriented, highly organized, and experienced in utilization review and prior authorizations. They are comfortable interpreting clinical documentation, navigating payer requirements, and communicating clearly with patients and healthcare staff. They are proactive, collaborative, and committed to supporting quality patient care. Job Summary: The Botox Utilization Review Specialist is responsible for obtaining insurance authorization for therapeutic Botox injections, including treatments for migraines, spasms, dystonia, and hyperhidrosis. This role reviews medical records for clinical necessity, verifies benefits, submits authorization requests, and manages denials and appeals. Strong knowledge of insurance processes, medical terminology, and documentation standards is required to ensure timely treatment approval. Job
Review medical records to validate diagnoses and supporting documentation Submit prior authorization requests using appropriate ICD-10 and CPT codes Verify medical necessity based on payer-specific clinical criteria Coordinate with insurance carriers to confirm eligibility, benefits, and coverage limitations Track pending, approved, and denied authorizations within the electronic health record Research denied requests and submit appeals with required clinical documentation Communicate authorization status and potential out-of-pocket costs to patients and clinical staff Maintain accurate records while handling confidential information with professionalism Prerequisites / License & Certification Requirements: High School Diploma or GED Minimum of 3 years of experience in prior authorizations, referrals, or a related medical office role Knowledge of insurance processes and medical terminology Experience using Athena is required Understanding of ICD-10 and CPT coding Strong multitasking and organizational skills Ability to perform efficiently in a high-volume, fast-paced environment Excellent communication, problem-solving, and team collaboration skills
If you’re ready to contribute your skills to a respected neurology practice and grow within a supportive environment, please submit your updated resume for confidential consideration. Cover letters and references are encouraged but not required. High School Diploma or GED 3+ years of prior authorization experience Athena EHR experience required ICD-10 and CPT coding knowledge Insurance verification experience
Candidates must have a high school diploma and at least 3 years of experience in prior authorizations or a related medical office role. Proficiency with Athena EHR and knowledge of ICD-10 and CPT coding are required.
Market context
In Arizona, administration roles in healthcare often draw steady interest because employers look for candidates who can support patient-facing operations while meeting compliance requirements. This type of role is competitive when applicants already have healthcare experience, a BHT certification, and a fingerprint clearance card, with an associate degree in Behavioral Health often preferred. Review the AI-summarized requirements and benefits here to quickly confirm fit before applying, which can save research time.
